It usually occurs prior to waking. I get a sharp pain in one

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It usually occurs prior to waking. I get a sharp pain in one or both eyes followed by a profuse discharge of fluid or tears. The pain is ongoing & seems to come in waves as does the discharge. It lasts between 10 - 30 minutes then goes away. Described symptoms during last eye exam and was told nothing structurally wrong with my eyes and no sign of disease. Frequency is irregular. Months can go by before it happens again. Any ideas would be appreciated.

Hello and thanks for your question. I assume this happens in both eyes? Have you had an incidental trauma to the eyes, such as a paper scratch, a twig glancing across the front of the eye, or a fingernail scratch?

Customer: No, and it does sometimes occur in just one eye.

Doctor DanB :

Do you wear contact lenses? Does it feel like someone has ripped the skin off your eyes?

Customer: I don't wear contacts. Tried them over 10 years ago but would wake up with my lower eyelids filled with a mucus like substance. I wear glasses. It sort of feels like a tiny bubble pops on the surface of my eye.

Doctor DanB :

Your symptoms can be from a handful of different causes. Sometimes people wake up with a stabbing pain that almost feels as though someone ripped the skin right off their eyeball. If this sounds familiar than this is likely a corneal abrasion or scratch. For people who describe waking up to this type of phenomenon, they sometimes have a history of an incidental trauma such as a twig glancing across the front of their eye, or a paper scratch or child's fingernail scratch to the eyeball at some point in the past. This incidental trauma can set off a reaction in the epithelium (superficial most layer of the cornea) that causes that portion of the epithelium to no longer adhere its underlying stromal (substance) tissue of the cornea, predisposing to corneal abrasions, or scratches, that often present like this. The kicker about this is, though, even when the patient makes it into the eye doctor's office within a few hours of the onset of the pain, the scratch is often times completely healed or almost totally healed so that there is very little to no evidence of this. In this respect, the patient's historical encounter goes a long way towards the diagnosis, which is called recurrent abrasion or recurrent erosion syndrome.

Even if you don't have that characteristic sensation of having the front of your eyeball ripped off upon first wakening, this may still be a corneal abrasion or scratch, even if it is not related to a recurrent abrasion syndrome. Just rubbing the eye, or having gotten something in the eye can cause an abrasion which may lead to this sharp, stabbing pain; in many instances this can feel like a foreign-body is in the eye as well.

In the absence of a corneal abrasion, this could also be related to just a dry, irritated eye. Dry eyes often times provide this stabbing pain in the eye which can last for several hours to days.

My first treatment advice for all of these problems would be to start using artificial tears 4-5x/day in both eyes on a consistent, daily basis. You can also use some lubricating ophthalmic ointment, although the use of that will certainly blur the vision, so you may choose to use that only before you go to bed, or after work at the very least. You can buy both of these over-the-counter at the drug store; generics work just fine, just don't buy any artificial tears that say get-the-red-out or redness reliever.

Alternatively, if this recurrent abrasion scenario sounds familiar you could also try using Muro 128 ointment in your eyes at night, before you go to bed. You can buy this over-the-counter in most drug stores. This can help with this recurrent abrasion syndrome which you may have.

Doctor DanB :

Does that make sense?

Customer: Sounds reasonable but not something I did not already discover on my own. Can you explain the pulsating nature of the pain and fluid discharge. Why it occurs on an irregular & infrequent schedule. Are there any direct or indirect evidence of such a diagnosis. Is there any out of the box Dr. House type possible reasons for what is going on with my eyes.

Doctor DanB :Are the teary discharge comes in pulses because that is the way is released from the lacrimal gland, in pulses and spurts. The pain pulses because the pain you are experiencing is referred from the cornea to the pupil and when the pupil constricts and dilates it aches because that is where the sensory nerves are felt most in the eyes from scratch on the front of the eye. As far as outside of the box diagnoses, this can also be an exuberant conjunctivitis causing pebbling or bumps on the undersurface of your eyelid that cause the friction against the cornea. Lastly, trigeminal neuralgia is pretty outside of the box and is a possible cause of pain and testing like you've described but its pretty uncommon and not usually seen on both sides.

Customer: In those other conditions are there straight forward connect the dot type evidence. Would any of these conditions leave clues after the fact. Are there any indirect tests or evidence associated with these conditions.

Doctor DanB :A papillary conjunctivitis is often times not identified as a cause for this unless the eye doctor everts the upper eyelid to look for it. This does not always happen unless it is something specifically looked for. The trigeminal neuralgia does not show any physical signs on examination. It is entirely a historical related diagnosis, though sometimes if there are mass lesions in the brainstem causing it they can be visible on MRI scan.

Doctor DanB :One of the hallmarks, however, of recurrent abrasion syndrome is that by the time the patient makes it to the eye doctors office the abrasion has resolved and there is no evidence that anything has ever happened. This sounds to be the case with you and why I suspect this diagnosis in you in addition to your historical account of your symptoms.

Doctor DanB :Do you have any other questions about this?

Customer: Does the fact that wearing contacts caused a mucus like substance to collect in lower eyelids upon waking offer any insight into the architecture or biology of my eyes?

Doctor DanB :Well it does not categorically mean you have any anatomical abnormality with your eyes, it does speak to the fact that you produce an exuberant inflammatory in response to a foreign body. This could indicate that this papillary conjunctivitis may be more likely.

Customer: Thanks for you time.

Doctor DanB :My pleasure. Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!

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